A review and psychometric evaluation of pregnancy-specific stress measures

Abstract

Considerable evidence has accumulated on the association between pregnancy-specific stress and adverse birth outcomes with an increasing number of measures of pregnancy-specific stress being developed internationally. However, the introduction of these measures has not always been theoretically or psychometrically grounded, resulting in questions about the quality and direction of such research. This review summarizes evidence on the reliability and validity of pregnancy-specific stress measures identified between 1980 and October 2010. Fifteen pregnancy-specific stress measures were identified. Cronbach’s alpha coefficient ranged from 0.51–0.96 and predictive validity data on preterm birth were reported for five measures. Convergent validity data suggest that pregnancy-specific stress is related to, but distinct from, global stress. Findings from this review consolidate current knowledge on pregnancy-specific stress as a consistent predictor of premature birth. This review also advances awareness of the range of measures of pregnancy-specific stress and documents their strengths and limitations based on published reliability and validity data. Careful consideration needs to be given as to which measures to use in future research to maximize the development of stress theory in pregnancy and appropriate interventions for women who experience stress in pregnancy. An international, strategic collaboration is recommended to advance knowledge in this area of study.

Keywords::

• Measurement
• pregnancy
• reliability
• stress
• validity

Declaration of Interest: The authors report no conflicts of interest

Current knowledge on the subject

• Research literature shows a consistent relationship between pregnancy-specific stress and adverse outcome

• Pregnancy-specific stress measures have successfully predicted premature birth

• A range of measures have been developed to measure pregnancy-specific stress have been developed internationally

What this study adds

• This review of 15 pregnancy-specific stress and anxiety measures demonstrated that quantity and quality of reliability and validity data were highly variable and that the reported theoretical grounding of measures was limited

• The findings consolidate current knowledge on pregnancy-specific stress as a predictor of premature birth

• This paper identifies the need for an international, strategic collaborative approach to increase numbers and diversity of women studied over the course of pregnancy to provide significant progress in addressing current psychometric limitations